Journal of Academic Ophthalmology
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Current Models for Inpatient and Emergency Room Ophthalmology Consultation in U.S. Residency Programs
No full textAbstract
Objective This article examines models of patient care and supervision for hospital-based ophthalmology consultation in teaching institutions.
Design This is a cross-sectional survey.
Methods An anonymous survey was distributed to residency program directors at 119 Accreditation Council for Graduated Medical Education accredited U.S. ophthalmology programs in the spring of 2018. Survey questions covered consult volume, rotational schedules of staffing providers, methods of supervision (direct vs. indirect), and utilization of consult-dedicated didactics and resident competency assessments.
Results Of the 119 program directors, 48 (41%) completed the survey. Programs most frequently reported receiving 4 to 6 consults per day from the emergency department (27, 55.1%) and 4 to 6 consults per day from inpatient services (26, 53.1%). Forty-seven percent of programs reported that postgraduate year one (PGY-1) or PGY-2 residents on a dedicated consult rotation initially evaluate patients. Supervising faculty backgrounds included neuro-ophthalmology, cornea, comprehensive, or a designated chief of service. Staffing responsibility is typically shared by multiple faculty on a daily or weekly rotation. Direct supervision was provided for fewer of emergency room consults (1–30%) than for inpatient consults (71–99%). The majority of programs reported no dedicated didactics for consultation activities (27, 55.1%) or formal assessment for proficiency (33, 67.4%) prior to the initiation of call-related activities without direct supervision. Billing submission for consults was inconsistent and many consults may go financially uncompensated (18, 36.7%).
Conclusion The majority of hospital-based ophthalmic consultation at academic centers is provided by a rotating pool of physicians supervising a lower level resident. Few programs validate increased levels of graduated independence using specific assessments
Virtual Ophthalmology Rotations—A Real Possibility during the COVID-19 Pandemic and Beyond
No full textThe Early Impact of COVID-19 on Ophthalmology Resident Training and Wellness
No full textAbstract
Objective The aim of this article is to assess the initial impact of the coronavirus disease 2019 (COVID-19) pandemic on ophthalmology resident training and wellness.
Design Online national survey of ophthalmology residents distributed by residency program directors and education coordinators of participating programs.
Setting US ophthalmology residency programs during the COVID-19 pandemic (May 20th, 2020 to June 10th, 2020).
Participants Ophthalmology residents enrolled in the US residency programs currently in postgraduate years two through four of training.
Results Two-hundred thirty-six of 785 (30.1%) residents responded to the survey. One-hundred eighteen of 234 (50.4%) residents reported exposure to known COVID-19 positive patients, and of those exposed, 44 of 118 (37.2%) felt that they did not have adequate personal protective equipment. One-hundred ninety-five of 233 (83.7%) residents reported a decrease in primary surgical cases during the pandemic, with 68 (29.2%) reporting a loss of more than 50 primary cases. One-hundred sixty-four of 234 (70.1%) residents were concerned that the pandemic would negatively impact their surgical skills beyond residency, and 15% reported that they were more likely to pursue fellowship due to the pandemic. 31.0% of residents met criteria of burnout, 9.1% were depressed, and 13.4% had generalized anxiety. Concerns about COVID-19 infection were correlated with increased anxiety and burnout during the pandemic.
Conclusions The COVID-19 pandemic has decreased resident surgical and clinical volumes and has negatively impacted ophthalmology residency training. Residents with increased concern for contracting COVID-19 and those actively engaged in a job search had significantly higher odds of increased anxiety
A Characterization of Ophthalmology Residency Program Social Media Presence and Activity
No full textAbstract
Objective To determine the presence and activity of ophthalmology departments associated with residency programs on social media platforms and the use of these social media platforms by residency applicants.
Design Cross-sectional online assessment of ophthalmology training program departments\u27 presence and activity on Facebook, Twitter, and Instagram.
Participants A total of 120 accredited ophthalmology residency training programs and 498 ophthalmology residency applicants.
Methods Each department was evaluated by (1) searching for social media links on the department\u27s Web site, (2) searching for the department on Facebook, Twitter, and Instagram, and (3) searching on Google. A simultaneous survey was conducted to assess social media platform use of 2019 to 2020 ophthalmology residency application cycle candidates.
Main Outcomes The presence of ophthalmology departments on Facebook, Twitter, and Instagram, as well as the total number of followers and posts during January 2020.
Results Of 120 programs evaluated, 45 programs (37.5%) had a Facebook page, 29 (24.3%) were on Twitter, and 22 (18.3%) had an Instagram page. Among top 20 Doximity-ranked ophthalmology programs, 80% had at least one social media page on Facebook, Twitter, or Instagram compared with 33% among the remainder of programs (chi-square test = 15.2, p \u3c 0.001). Top 20 programs also had more followers compared with others on Facebook (4,363 vs. 696, respectively, p \u3c 0.0001) and Twitter (3,673 vs. 355, respectively, p = 0.007) but not on Instagram (1,156 vs. 1,687, respectively, p = 0.71). Among 498 residency applicants to Bascom Palmer Eye Institute from the 2019 to 2020 cycle, 159 (31.9%) responded to a survey regarding their use of social media during the application process. In total, 54 (34%) responded that they used social media to evaluate residency programs.
Conclusion Departments of top 20 ophthalmology residency had both a greater presence and following on social media compared with other departments. While Facebook was the most used platform by ophthalmology departments, applicants most commonly used Instagram. As applicants come to use these social media resources more frequently, ophthalmology residency programs may increasingly benefit from maintaining an active social media page
Predictors of Manual Dexterity in Simulation-Based Cataract Surgery
No full textAbstract
Introduction The aim of this study is to determine if prior experience with fine motor hobbies influences a surgeon-in-training\u27s performance on a cataract surgical simulator.
Materials and Methods Medical students (n = 70) performed navigation, forceps, and capsulorhexis simulations using the Eyesi Ophthalmosurgical Simulator. Participants were surveyed regarding fine motor hobby experiences, including musical instruments, video games, sewing, knitting, origami, painting, crafting, jewelry making, drawing, and extracurricular dissection.
Results Medical students with extracurricular dissection experience, including work in research laboratories involving microscopic animal dissection, did significantly better on the forceps simulator task (p = 0.009). Medical students with drawing experience performed better on capsulorhexis (p = 0.031). No other fine motor hobbies were significant for improving simulator scores.
Conclusion Drawing and extracurricular dissection lend to improved technical ability on the cataract surgical simulator. This research continues the conversation regarding fine motor hobbies that correlate with microsurgical ability and adds to the growing area of research regarding the selection and training of ophthalmology residents
Ophthalmology Clinic for the Homeless in San Francisco: Experiences and Findings
No full textAbstract
Background Homelessness is a growing area of concern for communities around the world and homeless individuals are often not connected to healthcare and, consequently, this population is often left out of crucial studies that influence the care provided at public hospitals. The main aim of this study is to examine the prevalence of eye disease, demographics, and common comorbidities of patients who utilized the student-run, institution-sponsored ophthalmology clinic for homeless individuals across a 2-year period. A secondary aim was to elucidate the role that student-run clinics can play in connecting the homeless population to healthcare and community services.
Methods A retrospective cohort study examined individuals who utilized a student-run, free ophthalmology clinic at two homeless shelters in an urban community for 2 years, from 2017 to 2019.
Results A volunteer sample consisting of 123 residents at two homeless shelters who signed up to receive an eye examination at the free eye clinic. The average age of participants was 51 years, with 74% identifying as male, and the largest number of patients identified as African-American/Black (33%) and White (27%). The most prevalent eye disease was refractive error at a prevalence rate of 70% with presbyopia and myopia accounting for 77% and 42% of the refractive error diagnoses, respectively. A visually significant cataract was the second most prevalent pathology, which was diagnosed in 13% of patients. Diabetic retinopathy had a prevalence rate of 11%. Glaucoma had a prevalence rate of 20%. When stratifying the prevalence of glaucoma by race/ethnicity, Black/African-Americans had a prevalence rate of 30% and Asians had a prevalence rate of 29%.
Conclusion This study demonstrated a high prevalence of eye disease among the homeless population highlighting the major role that social determinants of health play in patient outcomes. Student-run ophthalmology clinics provide rich educational experiences, and most importantly, connect homeless populations to essential ophthalmologic care
The Flipped Classroom: An Innovative Approach to Medical Education in Ophthalmology
No full textAbstract
Objective The aim of the study is to report the creation of a flipped ophthalmology course and preclinical medical student perceptions and knowledge gains before and after a flipped ophthalmology course.
Design The form of the study discussed is an observational study.
Subjects The subjects involved in the study are second-year (U.S.) United States medical students at the University of Miami, Miller School of Medicine (n = 401).
Methods Second-year medical students participated in a 1-week “flipped classroom” ophthalmology course geared toward primary care providers at the University of Miami, Miller School of Medicine. Eleven hours of traditional classroom lectures were condensed into 4.5 hours of short videos with self-assessment quizzes, small group discussions, and a large group case-based discussion. Fifty-seven short videos (\u3c9 minutes) focused on major ophthalmology topics and common conditions were viewed by the students at their leisure. Students completed a pre- and post-course evaluation on their perceptions and opinions of the flipped classroom approach. Final exam scores in the flipped classroom cohort were compared with the final exam scores in the traditional didactic format used in years prior.
Main Outcome Measures The main outcome measures include: student final exam performance; student satisfaction, opinions, and perceptions.
Results Over the course of 2 years, 401 second-year U.S. medical students participated in the flipped classroom ophthalmology course. The majority of students enjoyed the flipped classroom experience (75.3%) and expressed interest in using the approach for future lessons (74.6%). The flipped classroom videos were preferred to live lectures (61.2%). Over 90% of students stated the self-assessment quizzes were useful, 79% reported that the small group discussions were an effective way to apply knowledge, and 76% cited the large group case-based discussion as useful. Pre-course knowledge assessment scores averaged 48%. Final examination scores in the flipped group (average ± standard deviation [SD] = 92.1% ± 6.1) were comparable to that of the traditional group when evaluating identical questions (average ± SD = 91.7% ± 5.54), p = 0.34.
Conclusion The flipped classroom approach proved to be a well-received and successful approach to preclinical medical education for ophthalmology. This was achieved using 35% less course time than our traditional course. This innovative approach has potential for expansion to other medical schools, medical education abroad, and for other medical school modules
Implementation of COVID-19 Protocols and Tele-Triage in an Academic Ophthalmology Department
No full textAbstract
Background The coronavirus disease-2019 (COVID-19) pandemic has affected academic ophthalmology departments globally, causing changes in educational, research, and clinical operations in the short and long term. Healthcare workers are at higher risk of contracting the disease and given early reports suggestive of transmission through the tear film in COVID-19 cases with conjunctivitis, and close proximity during examination, eye care providers in particular may be at increased risk.
Objective To provide the experience from a single academic ophthalmology program in responding to the COVID-19 pandemic.
Methods This article describes the changes executed in the Department of Ophthalmology and Visual Sciences at the University of Illinois at Chicago, Illinois Eye and Ear Infirmary, with emphasis on the implementation of a tele-triage process for urgent visits.
Results In response to the pandemic, our department made rapid changes to its departmental protocols for education, research, and patient management. Early measures focused on limiting face-to-face interactions among patients, staff, residents, and faculty, decreasing the risk of exposure to disease while also providing access for patients in urgent need of care.
Conclusion We hope that the UIC experience will assist other academic tertiary referral centers in maximizing their opportunities to deliver excellent patient care while minimizing risks to patient and provider, all while continuing to provide a quality graduate medical educational experience during and beyond the pandemic
The New Ophthalmology Internship: A Trainee Curricular Survey
No full textAbstract
Background The American Academy of Ophthalmology, in conjunction with the Accreditation Council of Graduate Medical Education (ACGME), has mandated the creation of a linked ophthalmology internship year for all programs by 2021. This mandate provides a unique opportunity to tailor a curriculum specific to the ophthalmology trainee. This study reports the results of a national survey of ophthalmology residents and fellows regarding the relevance and applicability of extramural content to their ophthalmology training.
Methods Using the online portal SurveyMonkey, an anonymous survey was sent to 119 ACGME-accredited ophthalmology residencies. It consisted of nine questions formulated to measure the perceived applicability and relevance of other specialties to ophthalmology training. Responses were summarized with descriptive statistics. Outcomes were compared by one-way analysis of variance with Tukey\u27s post hoc analysis for between group differences and Benjamini–Hochberg for multiple comparisons.
Results Ninety-four respondents (residents and fellows) completed the survey (January–February 2020); 52.1% completed an internal medicine internship, 42.6% transitional, and 5.3% general surgery. Overall, prior internship experience was rated favorably. Otolaryngology and radiology were deemed the most relevant to ophthalmology training. Intensive care unit (ICU) was considered the least beneficial, followed by general surgery, primary care, and pediatrics. Neuroradiology was overwhelmingly preferred over general radiology. The majority of respondents reported minimal exposure to oral and maxillofacial surgery (OMFS) in medical school/internship. When choosing a reason for inclusion in the new curriculum, respondents reported a high level of surgical overlap with otolaryngology, OMFS, and plastic surgery; clinical overlap with neurology; and ophthalmic consultation with emergency medicine.
Conclusion Several specialties—notably otolaryngology, radiology, and neurology—were considered highly relevant but lacking in preresidency exposure. The preference for neuroradiology was almost unanimous. In contrast, general surgery and ICU were found to be minimally relevant. Overall, ophthalmology residents reported a high level of satisfaction with their internship experience, an important consideration when building a curriculum that will appeal to potential applicants. The findings of this survey provide a framework to build a curricular plan based on current resident and fellow experience